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Rodríguez de Vera Gómez P, Méndez Muros M, Torres Cuadro A, Toyos Sáenz de Miera FJ, López Ruiz R, Guerrero Vázquez R, García González JJ, Garrido Hermosilla AM, Martín Hernández T. Alemtuzumab induces severe orbitopathy in relapsing-remitting multiple sclerosis. J Neurol 2024; 271:486-496. [PMID: 37773417 DOI: 10.1007/s00415-023-11995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/01/2023]
Abstract
CONTEXT Treatment with Alemtuzumab (ALZ) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise. AIM The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ METHODS: This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014-2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment. RESULTS A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis. CONCLUSIONS We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option.
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Affiliation(s)
- Pablo Rodríguez de Vera Gómez
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain.
| | - Mariola Méndez Muros
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain.
- Andalusian Reference Unit for Graves' Orbitopathy (UPRA) Endocrinology, Seville, Spain.
| | - Alberto Torres Cuadro
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain
| | | | - Rocío López Ruiz
- Neurology Department, University Hospital Virgen de la Macarena, Seville, Spain
| | - Raquel Guerrero Vázquez
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain
| | | | - Antonio Manuel Garrido Hermosilla
- Ophthalmology Department, University Hospital Virgen de la Macarena, Seville, Spain
- Andalusian Reference Unit for Graves' Orbitopathy (UPRA) Endocrinology, Seville, Spain
| | - Tomás Martín Hernández
- Endocrinology and Nutrition Department, University Hospital Virgen de la Macarena, Avenida Dr Fedriani 3, 41009, Seville, Spain
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de Vera Gómez PR, Aguado JM, González MM, Hernández TM, Idoate MA. Cystic parathyroid lesions: concerning a rare heterogeneous entity-two case reports. Hormones (Athens) 2022; 21:189-191. [PMID: 34822134 DOI: 10.1007/s42000-021-00340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | - Tomás Martín Hernández
- Endocrinology and Nutrition Department, University Hospital Virgen Macarena, Seville, Spain
| | - Miguel A Idoate
- Pathology Department, University Hospital Virgen Macarena, Seville, Spain.
- Pathology Department, University Hospital & School of Medicine, University of Seville, Avda. Fedriani, 3, 41009, Seville, Spain.
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Arana C, Moreno-Fernández AM, Gómez-Moreno G, Morales-Portillo C, Serrano-Olmedo I, de la Cuesta Mayor MC, Martín Hernández T. Increased salivary oxidative stress parameters in patients with type 2 diabetes: Relation with periodontal disease. ACTA ACUST UNITED AC 2017; 64:258-264. [PMID: 28495321 DOI: 10.1016/j.endinu.2017.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether there are differences in salivary oxidative stress between patients with diabetes mellitus type 2 (DM2) and healthy non-diabetic patients, and whether this oxidative stress is associated with the presence of periodontal disease in diabetic patients. MATERIAL AND METHODS This observational study included 70 patients divided into three groups according to metabolic control levels: 19 non-diabetic patients (control group); 24 patients with good metabolic control (HbA1c<7%), and 27 patients DM2 with poor metabolic control (HbA1c>7%). The following oxidative stress parameters were measured in all subjects: glutathione peroxidase (GPx), glutathione reductase (GRd), reduced glutathione (GSH) and oxidized glutathione (GSSG). Periodontal health was determined by means of the community periodontal index (CPI) recommended by the WHO. RESULTS The diabetic group with good metabolic control showed a significant increase in GPx and GRd activity in comparison with the control group (P<.001). The activity of the enzymes measured was significantly less in patients with poor metabolic control in comparison with the control group and well-controlled diabetic groups (P<.001). Both diabetic groups showed higher GSSG/GSH quotients and CPI in comparison with the control group, and both parameters were significantly higher in diabetic patients with poor metabolic control in comparison with well-controlled diabetic patients. CONCLUSIONS Poor metabolic control in DM2 patients is associated with higher levels of salivary oxidative stress and worse periodontal health.
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Affiliation(s)
- Carlos Arana
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Ana María Moreno-Fernández
- Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Gerardo Gómez-Moreno
- Departamento de Odontología en Pacientes Especiales, Grupo de Investigación Farmacológica en Odontología CTS-654 de la Junta de Andalucía, Facultad de Odontología, Universidad de Granada, Granada, España
| | | | - Isabel Serrano-Olmedo
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Tomás Martín Hernández
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
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Arana Molina C, González Rivera N, Gómez-Moreno G, Farfan Lopez F, Martín Hernández T. Sellar collision tumor involving a primary fibrosarcoma: Clinical, morphological and immunohistochemical study of a case and review of the literature. ACTA ACUST UNITED AC 2017; 64:176-178. [PMID: 28440757 DOI: 10.1016/j.endinu.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Carlos Arana Molina
- Endocrinology and Nutrition Unit, Virgen Macarena University Hospital, Seville, Spain.
| | | | - Gerardo Gómez-Moreno
- Department of Special Care in Dentistry Group, Pharmacological Research in Medicine, Faculty of Dentistry, University of Granada, Granada, Spain
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Albero Tamarit A, Torres Cuadro A, Martín Hernández T. Considerations about document of Spanish consensus for the management of patients with advanced radioactive iodine refractory differentiated thyroid cancer (CDT-RAI). ACTA ACUST UNITED AC 2016; 64:123-124. [PMID: 27256960 DOI: 10.1016/j.endonu.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 04/14/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ana Albero Tamarit
- Unidad de Gestión Clínica de Oncología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Alberto Torres Cuadro
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Tomás Martín Hernández
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España
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Molina CA, Ojeda LF, Jiménez MS, Portillo CM, Olmedo IS, Hernández TM, Moreno GG. Diabetes and Periodontal Diseases: An Established Two-Way Relationship. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jdm.2016.64024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Arana C, Pérez de León JA, Gómez-Moreno G, Pérez-Cano R, Martín Hernández T. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) treated with autologous hematopoietic stem cell transplantation: a case report and literature review. Am J Case Rep 2015; 16:124-9. [PMID: 25726020 PMCID: PMC4349133 DOI: 10.12659/ajcr.892837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND POEMS syndrome is a rare systemic pathology of paraneoplastic origin that is associated with plasma cell dyscrasia. It is characterized by the presence of sensorimotor polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes, and other systemic manifestations. The pathogenesis of the syndrome is unknown but over-production of vascular endothelial growth factor is probably responsible for most of the more characteristic symptoms. There is no standard treatment for POEMS syndrome and no randomized controlled clinical trials of treatment exist in the available literature. High-dose melphalan with autologous hematopoietic stem cell transplantation should be considered for younger patients with widespread osteosclerotic lesions, and for patients with rapidly progressive neuropathy. CASE REPORT This is the case of a 62-year-old Caucasian man who was admitted to our center presenting pretibial edema accompanied by significant weight loss and difficulty walking. POEMS criteria were present and an immunofixation test confirmed the presence of a monoclonal plasmaproliferative disorder. After autologous hematopoietic stem cell transplantation, the monoclonal component disappeared and the patient's clinical status improved markedly. CONCLUSIONS Autologous hematopoietic stem cell transplantation following high-dose melphalan is an effective therapy for younger patients with widespread osteosclerotic lesions in POEMS syndrome.
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Affiliation(s)
- Carlos Arana
- Endocrinology and Nutrition Clinical Administration Unit, Virgen Macarena University Hospital, Sevilla, Spain
| | | | - Gerardo Gómez-Moreno
- Department of Special Care in Dentistry, Pharmacological Research in Dentistry, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Ramón Pérez-Cano
- Internal Medicine Clinical Administration Unit, Virgen Macarena University Hospital, Sevilla, Spain
| | - Tomás Martín Hernández
- Endocrinology and Nutrition Clinical Administration Unit, Virgen Macarena University Hospital, Sevilla, Spain
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Arce MB, Molina TC, Hernández TM, de la Cinta Calvo Morón M, Herrero CH, De La Riva Pérez PA, Montaño JC. Thymic uptake after high-dose I-131 treatment in patients with differentiated thyroid carcinoma: a brief review of possible causes and management. ACTA ACUST UNITED AC 2014; 62:19-23. [PMID: 25160708 DOI: 10.1016/j.endonu.2014.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 05/27/2014] [Accepted: 06/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To report five cases of patients diagnosed with differentiated thyroid carcinoma (DTC) with uptake in the thymic area after high-dose treatment with I-131 and to evaluate the potential causes and therapeutic management. METHODS Five cases of young female patients with a mean age of 36.6 years (24-43) who had been treated with a mean dose of 106 mCi of I-131 (100-150 mCi) showing tracer uptake in the thymic area are reported. An I-131 whole-body scan (131I-WBS) was performed 7 days after therapeutic dose administration to each patient. Anterior and posterior planar images, followed by SPECT/CT of the head, neck and superior mediastinum were acquired in all patients. Thyroglobulin levels were measured with and without hormone replacement therapy in all cases. Samples taken from the superior mediastinum were sent to pathology for analysis, which confirmed the presence of thymic tissue. RESULTS Two patients underwent elective total thymectomy due to the gross characteristics of the gland, local 131-I uptake, and high thyroglobulin levels. The remaining three patients had already undergone thymectomy as part of neck dissection during initial surgery, and no further invasive interventions were therefore performed. Pathological examination revealed no metastases in these five patients. CONCLUSIONS Thymus visualization in young patients after administration of therapeutic doses of I-131 seems to be a more common finding than usually thought. Absence of metastasis in the thymus despite high thyroglobulin levels was confirmed in all cases. Based on these results, we suggest that a more expectant and less aggressive therapeutic approach could be used. We also suggest that I-131 therapy for DTC should be considered in classification of the potential causes of true thymic hyperplasia in the subgroup of patients recovering from a stressor.
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Affiliation(s)
- Manrique Borbón Arce
- Department of Nuclear Medicine, Hospital Universitario Virgen Macarena, Seville, Spain.
| | - Teresa Cambil Molina
- Department of Nuclear Medicine, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | - Juan Castro Montaño
- Department of Nuclear Medicine, Hospital Universitario Virgen Macarena, Seville, Spain
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Manuel García-Quirós Muñoz J, Martín Hernández T, Torres Cuadro A, Cambil Molina T, Castro Montaño J, Sendón Pérez A. [Age of menopause in patients with differentiated thyroid cancer treated with radioiodine]. ACTA ACUST UNITED AC 2010; 57:105-9. [PMID: 20304710 DOI: 10.1016/j.endonu.2010.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 01/25/2010] [Accepted: 01/25/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Differentiated thyroid cancer (DTC) is an increasingly frequent endocrinological disease. Radioiodine is a key component of treatment. OBJECTIVE To analyze the effects of I(131) therapy on ovarian and reproductive function. MATERIAL AND METHODS We retrospectively analyzed data from 202 women treated with radioiodine for DTC in our service from 1985-2008. Data on age at menopause in patients and their mothers and sisters, menstrual history, fertility and neonatal abnormalities were collected. RESULTS Menopause occurred in 34 patients at follow-up. The mean age at menopause in patients was 49.94+/-3.45 while that in their mothers and sisters was 49.20+/-5.37 and 48.73+/-3.74 years, respectively. Three patients had transient amenorrhea. No infertility or neonatal alterations were found. CONCLUSIONS In our series, menopause did not occur earlier in patients than in their first degree relatives. No significant alterations in neonatal health, fertility or menstruation were found.
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Martín Hernández T, Torres Cuadro A, Yañez Fernández P, Gentil Baldrich A, Díaz Gálvez M, López Elorza F, Sendón Pérez Á. Utilidad de la determinación de tiroglobulina en aspirado de ganglios linfáticos de pacientes con carcinoma papilar de tiroides y anticuerpos antitiroglobulínicos positivos. ACTA ACUST UNITED AC 2009; 56:447-51. [DOI: 10.1016/s1575-0922(09)72965-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 10/05/2009] [Indexed: 11/26/2022]
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